[Sexual and Reproductive Life of Men and Women with Chronic Myeloid Leukemia: Opinion and Practical Considerations of the Fi-LMC Group].

In order to ensure safe outcomes for male and female patients with chronic myeloid leukemia (CML) and their children, the Fi-LMC group (France intergroupe de la LMC) discusses strategies regarding sexuality, contraception, fertility, procreation and breastfeeding. The working group underlines (1) the need for close collaboration between hematologists, andrologists, gynecologists/obstetricians and pharmacologists; (2) the importance of considering the thrombotic risk at diagnosis in case of marked hyperleucocytosis or thrombocytosis, as well as during pregnancy; (3) the need to discuss sperm banking or oocyte cryopreservation according to the individual risk of infertility; (4) personalized pregnancy management. Tyrosine kinase inhibitors (TKIs) administered during organogenesis are teratogenic, exposing to a risk of fetal loss, intrauterine growth restriction and congenital malformations. In cases of CML diagnosed during pregnancy, or unplanned pregnancy, continuation of pregnancy is generally possible without requiring systematic voluntary or medical termination. TKIs should be withheld during the entire first trimester, in favor of BCR::ABL1 monitoring or pegylated interferon-α depending on gestational age and hematologic presentation. For planned pregnancies, ideally in major or deep molecular response, several TKI withdrawal strategies are proposed, depending on their pharmacokinetics and on the patient's profile. From the second trimester onwards, imatinib or nilotinib can be reintroduced if needed. Dasatinib must be avoided throughout pregnancy. Data on bosutinib, ponatinib and asciminib remain insufficient. For patients wishing to breastfeed, TKIs must be discontinued sufficiently prior to delivery.